Responding to the Recruitment Challenge
A Shared Learning Project
www.360assurance.co.uk @360Assurance www.audityorkshire.nhs.uk @AuditYorkshire
Background and Areas Covered
• A project, not an audit
• Initial engagement with HR Directors & a system lead for HR and OD
• Over 20 organisations involved in the project and workshop held late November 2019
• Four areas covered: Aspects of streamlining, recruiting to hard-to-fill posts, apprenticeship levy and system working
www.360assurance.co.uk @360Assurance www.audityorkshire.nhs.uk @AuditYorkshire
Streamlining the Recruitment Process
• Key themes emerging from discussions about the recruitment process and monitoring the time taken to recruit
• NHS to NHS transfers and induction training
www.360assurance.co.uk @360Assurance www.audityorkshire.nhs.uk @AuditYorkshire
Recruiting to hard-to-fill posts
• Wide variety of initiatives being employed
• Some of the themes which emerged were: -
– Increasing use of social media
– Marketing and engagement
– Practical issues associated with some widely used initiatives such as international recruitment and ‘retire and return’
www.360assurance.co.uk @360Assurance www.audityorkshire.nhs.uk @AuditYorkshire
Utilisation of the Apprenticeship Levy
• Rules on utilising the Levy and public sector target
• Overall picture is one of increasing usage and expansion beyond nursing apprenticeships
• Some organisations have been able to meet and even exceed the public sector target
www.360assurance.co.uk @360Assurance www.audityorkshire.nhs.uk @AuditYorkshire
System Working
• Initial focus has been on developing system workforce strategies
• Multiple projects create challenges in ensuring sufficient resources are applied to system change
• There are practical issues that need to be overcome when staff work across organisations
• Some examples of effective system working are beginning to emerge
Creating a Supportive Staff Culture
Kevin Moynes Director of HR and OD
East Lancashire Hospitals NHS Trust 2013
Inside a 'failing' UK hospital
Channel 4 News
East Lancashire Hospitals NHS Trust 2018
10 ENABLERS OF EMPLOYEE ENGAGEMENT:
WHAT MATTERS TO ELHT STAFF
2018 Staff Survey Result
Early Resolution Policy
Patient Experience
Workforce Assurance Event
13th January 2020
Leadership,
Workforce and
Assurance
Deborah Hollings-Tennant
Head of Finance and
Operations
Assurance
Audit committee
Ensure that the organisation operates effectively
and meets its statutory and strategic objectives.
Provide it (i.e. the governing body) with assurance
that this is the case.
(HFMA –Audit committee handbook. 2018)
What are the requirements
• CQC Single Oversight Framework
• Annual Governance Framework
• Both aimed at ensuring that providers deliver
high quality care through safe and effective
staffing.
• Patient care is the true north.
What is the role of Leaders?
“Evidence shows that an organisation’s leadership
is the single biggest influence on culture:
paying attention to it will make success in
implementing the recommendations more likely.”
Developing workforce safeguards
NHSI 2018
Long Term Plan
Workforce and leadership are highlighted.
“The NHS’s greatest strength is its people, and
as demand for healthcare continues to grow, it
is essential that NHS staff get the support they
need to do their jobs effectively.”
Recruitment and Retention
Long Term Plan
“Through better recruitment and retention, the NHS
Long Term Plan will ensure there are enough
people working in the NHS to support patients, and
that they get the support they need to continue
delivering the best possible care.”
Recruitment and retention
What do we measure.
• Vacancies
• Agency spend
• Unfilled shifts
• Turnover
• Staff survey
Nursing
• Rostering creates efficiency.
• 90% nurses are women, many with caring
responsibilities. Does the roster help them?
• Or is agency more flexible.
• Do you know why your own staff are leaving. Or
just the numbers. Is there a safe mechanism for
capturing that data?
What might be going on behind the
data?
• Staff welfare
• Support to juggle work and family life
• Are staff feeling cared for?
• How do we handle complaints?
• How do we care for new starters, trainees, junior
doctors?
• Is this a great place to work?
• Do you want to know?
The King's Fund annual conference
2019: delivering population health
Professor Tom Bourne, Consultant
Gynaecologist, Queen Charlotte's and Chelsea
Hospital, Professor of Practice, Imperial College,
London.
• Junior doctors feel a lack of support. No tribe.
No common room. No human support network.
• How are placements at your organisation viewed
from the outside? Do you know?
• What is the leadership challenge?
BMJ
In 2017, 57.4% of Foundation Year 2 doctors did not enter
higher-training posts and 9000 doctors quit the NHS
entirely.
In 2011, when career-destination surveys were first
conducted, 71.3% of FY2 doctors progressed into higher
training-posts.
By 2016 this had dropped to 50.4% and last year the rates
had plummeted further to 42.6%.
The rate of decline is near exponential.
BMJ
“But perhaps what underpins it all, driving the
discontent and dissatisfaction, is a lack of feeling
valued and supported.
Three out of ten doctors have said they feel
unsupported by management each week, and that
they feel the mentoring provided to them as part of
their role has decreased.”
So what else is in the long term plan…
Long Term Plan
“It will also strengthen the quality of NHS
leadership, while improving the working
environment for frontline staff – from support to
manage their own health and wellbeing, to
investing in the digital technology that can help
them do their jobs more easily.”
Matt Hancock’s tech Vision
Matt Hancock’s tech vision
Dr Simon Eccles,
Chief Clinical Information Officer for Health and Care,
NHS England, said:
“Investing in excellent digital systems means
patients
can access the best and safest treatment pathways
available, as swiftly as possible at the
best value for taxpayers.”
PWC – Digital fitness app.
How digital ready is the workforce?
What’s the evidence?
https://www.youtube.com/watch?v=ttnXr0vxRBc
Technology is really about leadership and culture.
Poorly implemented tech change can increase
stress and reduce productivity.
So what about Leadership
• Make people feel cared for.
• Create supportive cultures.
• Drive considered innovation and change.
• Set clear direction.
• Be brave enough to face reality.
NHS People Plan – due out soon.
• Making the NHS the best place to work.
• Board responsibility for workforce
• Improving Leadership Cultures
• WRES engagement
• First time leader qualification.
NHS Leadership Academy
NHS Leadership Academy.
• Established after the Francis review.
• Based on behaviour, self awareness and the
NHS constitution
NHS Constitution
• Working together for patients
• Respect and Dignity
• Compassion
• Commitment to quality of care
• Improving lives
• Everyone counts.
Leaders are dealing with complexity.
The Leadership Academy Programmes
• Focus on the behaviours and impact of leaders.
• What’s it like to be on the end of me.
• Put the patient first.
• Create culture in which teams can thrive.
• Promote diversity and difference.
• Stand up for poor behaviour.
• Base decisions on sound data and evidence.
What is it like to be on the
receiving end of me?
• What does good leadership look like?
• What is the unintended consequence of the heroic model?
• Heroic leaders look strong, but can damage staff, patients and reputation.
• Kings Fund “The Future of Leadership and Management in the NHS - No More Heroes” 2011.
• Need a distributed model of leaders throughout the system.
Robert
Greenleaf
Servant
Leadership
Servant Leadership
Anybody could lead perfect people – if there were any. But there aren’t any perfect people….Many otherwise able people are disqualified to lead because they cannot work with and through the half people who are all there are. The secret …is to be able to wield a team of such people by lifting them up to be taller than they would otherwise be.
Robert Greenleaf
Servant leadership
1977.
What’s the leadership
culture in my organisation?
Good leaders seek feedback.
• Healthcare Leadership Model.
• Through one to one conversations.
• All the time.
Can this be measured?
Resilience
Resilience has Emotional, Mental and Physical aspects.
• Emotional – managing your state of heightened emotion in difficult circumstances. Not becoming too anxious. Not becoming too helpless.
• Mental – ability to recover your thinking capacity quickly after this has happened. Remaining realistically optimistic.
• Physical – self care to ensure not tired, unwell, hungry.
Do we create cultures that allow our leaders to do this?
Our programmes
• We have programmes for staff at all levels from
porter to chief exec.
• We are currently developing a “Licence to lead”
for all first time leaders.
• Aim to increase scale and spread of all our
programmes over the next five years.
Visit our website
• https://www.leadershipacademy.nhs.uk
• Great leadership development
improves leadership behaviours and skills.
Better leadership leads to better patient care,
experience and outcomes for the nhs.
Final Thoughts
• The NHS is run by people for people.
• Making them feel cared for is important.
• In a world of uncertainty and pressure leadership
is a quality that makes a difference.
Thank you for listening.
Any questions?……
60 © 2020 Best Companies Limited
Workforce
Assurance
Event
13th January 2020
61 © 2020 Best Companies Limited
“More staff not enough –
NHS must also be best place
to work” says new NHS people plan
62 © 2020 Best Companies Limited
As well as growing staff numbers, the NHS needs to rapidly become a
much better place to work says the new Interim NHS People Plan,
launched today (3rd June 2019) to address the once in a generation
workforce challenges the service is currently facing
1. How the NHS will rapidly increase the number of NHS staff, deliberately starting with
the nursing workforce where the current vacancy pressure is greatest.
2. How to make the NHS “the best place to work”, addressing current concerns from
frontline staff on the pressures they face, and improving retention rates.
3. How to equip staff and NHS frontline organisations to provide 21st century healthcare
including the need to join up health and care and take advantage of digital
technology, genomics and other innovations.
63 © 2020 Best Companies Limited
As well as growing staff numbers, the NHS needs to rapidly become a
much better place to work says the new Interim NHS People Plan,
launched today (3rd June 2019) to address the once in a generation
workforce challenges the service is currently facing
1. How the NHS will rapidly increase the number of NHS staff, deliberately starting with
the nursing workforce where the current vacancy pressure is greatest.
2. How to make the NHS “the best place to work”, addressing current concerns from
frontline staff on the pressures they face, and improving retention rates.
3. How to equip staff and NHS frontline organisations to provide 21st century healthcare
including the need to join up health and care and take advantage of digital
technology, genomics and other innovations.
64 © 2020 Best Companies Limited
65 © 2020 Best Companies Limited 65 © 2020 Best Companies Limited
Agenda
1. Engagement vs. Satisfaction
2. Our Methodology
3. The 2 Key Strategic Themes of Engagement
4. Organisational Clarity
5. Managerial Engagement
6. Questions?
66 © 2020 Best Companies Limited 66 © 2020 Best Companies Limited
1. Engagement vs.
Satisfaction
67 © 2020 Best Companies Limited
Engagement vs.
Satisfaction
Russell’s Circumplex
Theory of Affect (1980)
68 © 2020 Best Companies Limited
FREDERICK HERZBERG
MOTIVATION THEORY
ABRAHAM MASLOW
HIERARCHY OF NEEDS
Job Motivation
Job Dissatisfaction
Engagement vs. Motivation Theories
69 © 2020 Best Companies Limited
Engagement vs.
Satisfaction
Russell’s Circumplex
Theory of Affect (1980)
Dissatisfied
with Low
Motivation
Satisfied
with Low
Motivation
Dissatisfied
&
Motivated
Satisfied
&
Motivated =
Engagement
70 © 2020 Best Companies Limited
Engagement vs.
Satisfaction
Russell’s Circumplex
Theory of Affect (1980)
71 © 2017 Best Companies Limited
Vote Trigger
Vote Now
Highly Engaged Highly Satisfied Engaged but
Unsure
Satisfied but
Passive
Neutral Anxious but
Active Bored Highly Anxious Highly
Disengaged
How Engaged are you? 20
2.6%
26.3%
31.6%
15.8%
0.0%
13.2%
7.9%
2.6%
0.0%
1 2 3 4 5 6 7 8 9
72 © 2017 Best Companies Limited
Instant Pulse Survey
73 © 2020 Best Companies Limited 73 © 2020 Best Companies Limited
2. Our Methodology
74 © 2020 Best Companies Limited
Our Methodology
75 © 2020 Best Companies Limited
Headcount Adjusted BCI Score
76 © 2020 Best Companies Limited
Our 8 Workplace Factors
77 © 2020 Best Companies Limited
The My Manager Factor
78 © 2020 Best Companies Limited © 2020 Best Companies Limited
Core survey statements
Optional survey statements
My manager regularly expresses his / her appreciation when I do a good job
My manager treats everyone fairly
My manager does a lot of telling but not much listening
I feel that my manager talks openly and honestly with me
My manager cares about me as an individual
My manager shares important knowledge and information with me
My manager is an excellent role model for me
My manager helps me to fulfil my potential
My manager would be quick to respond if I showed signs of being under too
much pressure
My manager motivates me to give my best every day
I have confidence in the leadership skills of my manager
I feel that I lack support from my manager
My manager cares about how satisfied I am in my job
78 © 2020 Best Companies Limited
79 © 2020 Best Companies Limited © 2020 Best Companies Limited
Core survey statements
My team is fun to work with
I feel a strong sense of family in my team
People in our team don't care much for each other
Optional survey statements
Power struggles within my team have a negative impact
People in my team go out of their way to help me
© 2020 Best Companies Limited 79
80 © 2020 Best Companies Limited
The Leadership Factor
81 © 2020 Best Companies Limited © 2020 Best Companies Limited
Core survey statements
Optional survey statements
This organisation is run on strong values / principles
Senior managers truly live the values of this organisation
I have confidence in the leadership skills of the senior management team
I am inspired by the person leading this organisation
The leader of this organisation runs this organisation based on sound moral
principles
Senior managers of this organisation do a lot of telling but not much listening
© 2020 Best Companies Limited 81
82 © 2020 Best Companies Limited
The My Company Factor
83 © 2020 Best Companies Limited © 2020 Best Companies Limited
Core survey statements
Optional survey statements
I feel proud to work for this organisation
I believe I can make a valuable contribution to the success of this
organisation
I would leave tomorrow if I had another job
I love working for this organisation
My work is an important part of my life
© 2020 Best Companies Limited 83
84 © 2020 Best Companies Limited
The Personal Growth Factor
85 © 2020 Best Companies Limited © 2020 Best Companies Limited
Core survey statements
Optional survey statements
The experience I gain from this job is valuable for my future
There are limited opportunities for me to learn and grow within this organisation
The training in this job is a great benefit to me personally
This job is good for my own personal growth
I am bored with the work I do
© 2020 Best Companies Limited 85
86 © 2020 Best Companies Limited
The Wellbeing Factor
87 © 2020 Best Companies Limited © 2020 Best Companies Limited
Core survey statements
I am happy with the balance between my work and home life
I am under too much pressure at work to perform well
Optional survey statements
Most days I feel exhausted when I come home from work
I'm spending too much time working
My work interferes with my responsibilities at home
My health is suffering because of my work
My work deadlines are unrealistic
© 2020 Best Companies Limited 87
88 © 2020 Best Companies Limited
The Fair Deal Factor
89 © 2020 Best Companies Limited © 2020 Best Companies Limited
Core survey statements
I am paid fairly for the work I do relative to people in similar positions in
similar organisations
I feel I receive fair pay for the responsibilities I have in my job
Optional survey statements
I am happy with the pay and benefits I receive in this job
I am paid fairly for the work that I do relative to others within this
organisation
© 2020 Best Companies Limited 89
90 © 2020 Best Companies Limited
The Giving Something Back Factor
91 © 2020 Best Companies Limited © 2020 Best Companies Limited
Core survey statements
I believe this organisation does not do enough to protect the environment
This organisation has a strong social conscience
I think this organisation should put more back into the local community
This organisation is keen to help people from disadvantaged backgrounds
Optional survey statements
Profit / budget concerns are the only things driving this organisation
My organisation encourages charitable activities
© 2020 Best Companies Limited 91
92 © 2020 Best Companies Limited
Our 8 Workplace Factors
93 © 2020 Best Companies Limited © 2020 Best Companies Limited
Optional survey statements
I feel I can tell my manager when work is going badly
I feel my job is secure
Managers in my organisation would rather avoid conflict than deal with
issues
My manager takes an active interest in my wellbeing
I have skills that my organisation could use but doesn't
My manager ensures that I have the resources I need to do my job
Sometimes I feel that my manager takes advantage of me
© 2020 Best Companies Limited 93
94 © 2020 Best Companies Limited © 2020 Best Companies Limited
Optional survey statements
What is expected of me in my work is made completely clear to me
Senior Managers here are visible and approachable
The leader has a plan that I believe in
Some departments / teams in this organisation don't work well with each
other
I am excited about where this organisation is going
This organisation feels more reactive than proactive
Some people here use intimidation to get what they want
My organisation makes a positive difference to the world we live in
© 2020 Best Companies Limited 94
95 © 2020 Best Companies Limited 95 © 2020 Best Companies Limited
3. The 2 Key
Strategic Themes
96 © 2020 Best Companies Limited
Most highly correlated questions Pearson
Correlation
I think I have a positive future ahead of me in this organisation 0.806
I have confidence in the leadership skills of the senior management team 0.772
I love working for this organisation 0.743
My manager cares about how satisfied I am in my job 0.736
My manager helps me to fulfil my potential 0.732
I would leave tomorrow if I had another job 0.732
My manager is an excellent role model for me 0.732
I have a great deal of faith in the person leading this organisation 0.731
My manager motivates me to give my best every day 0.727
I feel proud to work for this organisation 0.723
My manager shares important knowledge and information with me 0.721
Everyone is treated fairly here 0.718
I have confidence in the leadership skills of my manager 0.715
I am inspired by the person leading this organisation 0.711
Senior managers truly live the values of this organisation 0.708
Top 15 most highly correlated questions NHS Clinical Organisation
Key
Managerial
Engagement
Organisational
Clarity
My Company
Questions
97 © 2020 Best Companies Limited
Most highly correlated questions Pearson
Correlati
on
This job is good for my own personal growth 0.764
My manager helps me to fulfil my potential 0.724
My manager motivates me to give my best every day 0.715
I feel proud to work for this organisation 0.713
I love working for this organisation 0.711
My manager cares about how satisfied I am in my job 0.708
I have confidence in the leadership skills of my manager 0.700
I have confidence in the leadership skills of the senior management team 0.686
This organisation is run on strong values / principles 0.686
My manager is an excellent role model for me 0.683
I would leave tomorrow if I had another job 0.681
I am excited about where this organisation is going 0.676
My manager would be quick to respond if I showed signs of being under too much
pressure 0.675
My manager cares about me as an individual 0.671
Senior managers of this organisation do a lot of telling but not much listening 0.669
Top 15 most highly correlated questions None Clinical NHS Organisation
Key
Managerial
Engagement
Organisational
Clarity
My Company &
Personal Growth
Questions
98 © 2020 Best Companies Limited 98 © 2020 Best Companies Limited
4. Organisational
Clarity
99 © 2020 Best Companies Limited © 2020 Best Companies Limited
Organisational Clarity – Start with Why?
Outside in/
Conventional Inside out/
Remarkable
Simon Sinek
100 © 2020 Best Companies Limited
Organisational Clarity
Outside in:
Conventional
Inside out:
Remarkable
101 © 2020 Best Companies Limited
Organisational Clarity – Primary Purpose
102 © 2020 Best Companies Limited © 2020 Best Companies Limited
Good Examples of Primary Purpose’s
“To open up the
world for those
who want to see”
“To connect everybody
to live a better today
and build a better
tomorrow”
103 © 2020 Best Companies Limited © 2020 Best Companies Limited
Good Examples of Primary Purpose’s
“To empower every
person and every
organisation on the
planet to achieve more”
“Give people the power
to build community and
bring the World closer
together”
104 © 2020 Best Companies Limited
Organisational Clarity – Core Principles
105 © 2020 Best Companies Limited © 2020 Best Companies Limited
Core Principles
106 © 2020 Best Companies Limited © 2020 Best Companies Limited
Core Principles
care
Care about what you
do, how you do it
and who you do it for
responsibility
Take 100%
responsibility
discipline
See the best in
yourself, see the
best in others
humility
Take what you do
seriously, but don’t
take yourself too
seriously
107 © 2020 Best Companies Limited
Organisational Clarity – Outrageous Ambition
108 © 2020 Best Companies Limited © 2020 Best Companies Limited
A Good Example of an Outrageous Ambition
We will create products that become pervasive around the
world.
We will be the first Japanese company to go into the
American market and distribute directly.
We will succeed with innovations like the transistor radio
that American companies have failed at.
Our brand name will be as well known as any on earth…
and will signify innovation and quality that rivals the most
innovative companies anywhere.
‘Made in Japan’ will mean something fine. Not shoddy.
109 © 2020 Best Companies Limited © 2020 Best Companies Limited
A Good Example of an Outrageous Ambition
To digitise every piece of
written information in the
world…within 300 years.
110 © 2020 Best Companies Limited
Organisational Clarity – Ingenious Plan
111 © 2020 Best Companies Limited
Organisational Clarity
112 © 2020 Best Companies Limited 112 © 2020 Best Companies Limited
5. Managerial
Engagement
113 © 2020 Best Companies Limited
How we measure Managerial Engagement
114 © 2020 Best Companies Limited
MOTIVATING
Energising
Inspiring
• My Manager treats everyone fairly
• What is expected of me in my work is made
completely clear to me
• My team is fun to work with
• My manager motivates me to give my best every day
• I have confidence in the leadership skills of
my manager
• My manager is an excellent role model for me
1. Motivating
Sell the direction and vision of the organisation and ensure others can see how their role impacts on the bigger picture.
115 © 2020 Best Companies Limited
CONSIDERING
Supporting
Recognising
• My manager ensures that I have the resources I need
to do my job
• My manager helps me to fulfil my potential
• I feel that I lack support from my manager
• My manager regularly expresses his/her appreciation when I do a good
job
• Sometimes I feel that my manager takes advantage of me
2. Considering
Recognise what you are asking from people and ensure this is realistic and achievable. Support people in achieving their tasks. Recognise and reward a job well done.
116 © 2020 Best Companies Limited
CONVERSING
Informing
Listening
• I feel that my manager talks openly and honestly with
me
• My manager shares important knowledge and
information with me
• My manager does a lot of telling but not much listening
• I feel I can tell my manager when work is going badly
3. Conversing
Open the channels for effective two-way communication. Share information in an open and honest way. Be open to receiving information from others.
117 © 2020 Best Companies Limited
CARING
Care
Understanding
• My manager cares about me as an individual
• My manager cares about how satisfied I am in my job
• My manager takes an active interest in my wellbeing
• My manager would be quick to respond if I showed signs of
being under too much pressure
4. Caring
Recognise people have a life outside of work, respect their time for family, friends and outside interests/hobbies.
Show an interest in them as individuals and demonstrate care for their needs.
118 © 2020 Best Companies Limited 118 © 2020 Best Companies Limited
119 © 2020 Best Companies Limited 119 © 2020 Best Companies Limited
6. Questions?
120 © 2020 Best Companies Limited
Thank You
Assurance at Workforce and Audit Committees
Steve Banks
Senior Independent
Director
Nottinghamshire Healthcare NHS
Foundation Trust
An Improving Workforce Assurance
Journey
Lots of data but no info
Lots of info but too tactical
The right supporting Committees but lose line of sight
Shorter papers but no numbers
SPCs but based on current performance not targets or benchmarks
Connection of Board, Audit, workforce, ELT and day job
Where do I get my
Assurance?
• Board Assurance Framework
• Controls
• Strategies, business plan, KPIs, policies etc
• External Sources, e.g.
• 360 Assurance, External audit, CQC, NHS toolkits
• Triangulation
• FTSU
Assurance or Re-assurance?
• Assurance about focus, effort, initiatives
• But not on outcomes?
• What is the best we can do in the national and local context?
• Good set of KPIs that can be validated, but what about workforce engagement?
• Engagement is in our gift and positively impacts on all the other measures
How do Workforce and Audit
work together?
• Share Board Assurance Framework (BAF) and movement (or not)
• Specific focus on each sub-committee risks annually
• Chair of Audit attends other sub-committees at least annually
• Annual report on effectiveness of sub-committees Vs TOR
• Summary of each sub-committee meeting
• Scrutiny of Internal Audit programme based on BAF
• Internal audit are your friends!
What would be
better?
• Short reports, traffic lights, ability to drill down
• Line of sight on actions
• Information that drives the right level of questions
• Forward looking
• Effective triangulation across Trust and sub-committees
www.360assurance.co.uk @360Assurance www.audityorkshire.nhs.uk @AuditYorkshire
Panel Discussion Chair: Steve Banks - Non-Executive Director at Nottinghamshire Healthcare NHS
Foundation Trust
Kevin Moynes - Executive Director of Human Resources and Organisational
Development (HR&OD) at East Lancashire Hospitals NHS Trust
Debbie Hollings-Tennant - Finance Director at NHS Leadership Academy
Jonathan Austin – CEO at Best Companies
Helen Grantham - Non-Executive Director at Leeds and York Partnership NHS
Foundation Trust
Julia Tabreham - Non-Executive Director at Derbyshire Healthcare NHS Foundation
Trust